What Makes a Good Doctor Pt II

While this writing comes fresh on the (white lab coat) tails of last week’s blog scribble regarding my unfortunate post-surgery visit with Dr. Slice and Dice*, the question of “what makes someone a good doctor” has rather noisily (and I admit stubbornly) rattled around in my brain for some time. This particular question, however, came to the forefront a few years back, when I found myself in under the watch of what I would deem as an unsafe doctor.

Here’s how the story went: at the time, in order to remain on the Manitoba renal transplant list, the Kidney Transplant Powers-That-Be insisted that all adult female patients undergo a yearly Pap test. I wanted to remain on that list. I was therefore on the hunt for a female GP. (As I type this out, it hits me that my actions towards finding a doctor based merely on the fact of their gender could be construed as sexist. But, if I can attempt to justify my (then) actions, here it is: the awkwardness of any doctor cramming fingers and cold metal contraptions and God knows what else into private parts is alleviated just slightly when that doctor has similar bits and pieces).**

Upon the recommendation of a friend, I was able to locate a female physician willing to accept new patients, Dr. Z was a diminutive and rather nervous individual, who had some remarkable bald spots peeking out from where her hair had been meticulously combed over. She likewise spoke in such a low whisper that I often had to ask her to repeat herself. Although annoying, I did not care; I had located a female GP to complete my exam! I was relieved. A week after she completed the poking and prodding, she brought me into her office, sat me down and delivered some spectacular news: I might be pregnant.

What the what?

Just to explain: I had been on peritoneal dialysis (PD) for years at this point. Individuals on PD rarely (read: never) get pregnant. It just does not happen. Okay, I suppose it could theoretically occur, but if it did happen, it would be either a fluke or a miracle. You decide.

I happen to have PD clinic the following day. At this appointment, I mentioned to my nephrologist that the GP thought that I might be pregnant. If you ever want to see a PD doctor’s face freeze and then be painted in fierce anger, blurt something like that out. Needless to say, the PD doctor immediately called Dr. Z to find out what (the bleepity bleep) was going on. Turns out, the GP had made a mistake. Oops.

It happens, right? Although Dr. Z’s (false) declaration brought up a poop-load of old pain for me, I let the error slide.

Then, a few months later, I needed to Dr.Z again. This time, it was not for anything medical, but rather, it was to have her fill out a health form for the renewal of Sean and my international adoption dossier. In the past, my previous GP would read through the paper, fill it out and immediately sign. It was not a big deal. I expected the same from Dr. Z.

But she refused. She refused to sign until I had an (in house) blood test. In retrospect, I should have asked what exactly she was testing. (Hindsight is so 20/20, eh? So annoying. I think if I met HIndsight in high school I probably wouldn’t have allowed her to sit at my cafeteria table. Who wants to eat lunch with someone that smug?). So I got Dr. Z’s silly test and didn’t think much more of it. That is, until she called me into her office. Naively, I figured I was being summoned so that she could sign those papers. But no.

It turns out that she had tested my blood for blankety blank,***something for which individuals who had undergone cancer treatments usually get tested. Again, what the what? I have never had cancer, nevermind been treated for it. But my results came back slightly (and oddly) elevated. Because of this, she once more refused to sign those dang adoption papers.****

I was getting desperate. We could not send our adoption dossier to Ethiopia without the papers. So when she (quietly) demanded that I get an endoscopy and colonoscopy as a follow-up to the slightly elevated blood work levels, I agreed. What else could I do? I was frantic, and like a dog wanting a treat, was willing to jump through whatever hoop she insisted upon. As I (figuratively) jumped, I literally had a tube shoved both down my throat and up my bum. The whole event was humiliating. And, it turns out, not necessary. Unsurprisingly, the results came back negative.

She then signed the papers.

And I found a new GP.

Here’s the tie-in to my question regarding what constitutes a good doctor: Dr. Z had come recommended to me by a friend. I don’t blame that friend for her suggestion; I should have questioned further when that individual had meant when she had shared that “Dr. Z is female. Dr. Z is such a good doctor”.

I hear it all the time: Dr. So-and-So is such a good doctor! The assumption is made that whomever is having such a conversation share the same values to what constitutes “good”.*****

So what does it mean to be a good doctor? The above scenario reflects a doctor whom I did not find to be acceptable in her profession. And as such, I soon left her practice. I have, however, over the thirty-six years I’ve been a chronic kidney disease (CKD) patient and especially after this most recent transplant, encountered many doctors who I would deem as not just good but rather, exceptional in their doctoring. When I think of those medical professionals who have, in my opinion, done their job well, I can summarize three characteristics (or values) that are present. These are in no particular order, and you are welcome to disagree with me about my summation. I am aware that we each walk around this earth with different values, and what I have come to appreciate in a medical professional may differ from what you need or value. That’s ok.

First, they are knowledgeable. This is more than just smart. Honestly, by the time a doctor is in practice, they have been around the educational block a few times. It takes a lot of fortitude and brain-ability to be trusted with people’s bodies. No, when I speak of knowledgeable, I mean the perfect collision of smart brains with clinical experience. I want my specialist to know more than I do. But I also want them to know who to call if a differing opinion is required. I want them to have connections. I likewise can appreciate a doctor who has had enough experience that my abnormal body things do not throw them off; that they can a) recognize my ailments and b) know what options are available to help with them, and c) not be phased by the strange things bodies sometimes do.

Second, I value availability. I get it; we all are busy. Doctors are busy. I do not expect a medical professional with hundreds of other patients to be at my beck and call. I would hope, however, that he or she is available post-surgery, especially if that surgery did not go well. Over the past months, I have repeatedly had the unfortunate occurrence of having to wait for the surgical specialist to “return from holiday” before I could move ahead with dealing with the lymphocele. Again, I understand. Doctors, like the rest of us, need vacations. But this particular surgeon’s escape to the Alps left me, his patient, to sit in health-care limbo for the six weeks until a consult could be arranged. Needless to say, while those six-weeks may have been a vacation for him/her, they were most definitely not an easy time for me or my family.

Lastly, I value caring. By this, I do not mean a bleeding heart (definitely not literally. That would be messy). No, I can appreciate a smart doctor who advocates for me and my health because they see me. On some level, they are able to put themselves in my position, and are thus motivated to do something beyond the required doctor-job: it’s the thoughtful recommendation of a friend who happens to be a lymphatic massage therapist. It’s the 5:15 pm phone call just to make sure that I am okay after a particularly difficult clinic. It’s walking me to an ultrasound appointment, as they could see that I am shaky on my feet and emotional after yet another dose of bad news. It’s laughing with me at the slippers I had to wear out in public, when my feet were too swollen to be contained in shoes. It’s those sort of things.

And to make a long story short, these are what I value in a "good" doctor.



*Dr. Slice and Dice may not be bad per se at his job, at least the technical side anyway. I assume that he has helped a lot of people. In fact, his ‘rate my doctor’ scores show that there are some extremely grateful individuals out there who have benefited from his surgical expertise. And while I’m thankful that he was willing to at least try to surgically deal with this dang lymphocele, I found him to be difficult to work with.

**bits and pieces = an amusing way to talk about bathing suit areas.

***I am using the highly specialized term, blankety blank because I cannot recall (this many years later) what the specific blood test was that she ordered. So blankety blank it is.

****if you have ever gone through the rigamarole of international adoption, you will be familiar with the ridiculous amount of paperwork involved.. At last count, during our time on the international adoption list, both Sean and I had completed seven criminal record checks each. Seriously. The receptionists at the police station where we did our checks soon got to know us. It was sort of like Cheers, where everyone knows your name. Except there was no booze. Or a bar. Or a Sam Malone. And we had to pay $85 each every time we showed up. Really, it wasn’t like Cheers at all.

*****the term “good” is being used in its colloquial sense, and not in the actual definition of a moral, upright being. That said, I am assuming the Hippocratic Oath covers that end of the meaning of a “good doctor”.

post-script: Later, when we confronted Dr. Z as to why she would bother to test me for that unnecessary test, she looked at me blankly and whispered “I test all my patients for that”. At that point, I remember thinking: you, dear ma’am, are a nutcase.